The outcomes of cataract surgery: a retrospective cohort study of a Boston clinic
Robinson, Steven James
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Cataract extraction has helped millions of people of all ages regain, at least to some extent, their vision. Throughout the natural aging process, the human lens becomes dense and opacified, decreasing the visual acuity of the affected person. Recent developments in microsurgery and intraocular lenses have made cataract surgery one of the most successful surgeries that can be performed, in terms of both visual improvement and low risk of complications. Still, it is unclear what justifies cataract surgery, as many times the indication for extraction of the lens is subjective. Visual acuity alone has been shown to be a poor criteria for surgery, as an improvement in acuity does not always correlate with an improvement in function. Instead, visual function that no longer meets the patient's needs is one of the most common reasons that cataract surgery is performed. Unfortunately, this is not an easily quantifiable measure, so many ophthalmologists differ on the level of significance required for the cataract to be removed. Efforts have been made to create standardized questionnaires that assess the effect of cataracts on a patients life, such as the VF-14, a 14 question survey that asks patients to rate the difficulty they have with tasks on a scale of 1-4. Their score is then calculated, and if the surgeon feels that surgery provides a reasonable expectation for improvement, the cataract is usually removed. Still, this practice is not widespread and there is no clear point where cataract extraction becomes justified. Measuring the outcome of cataract surgery is as challenging, if not more so, than determining if surgery is required. Visual function is the area where improvement is most crucial for quality of life, but increases in visual function are difficult to measure. Instead, many ophthalmologists chose to use visual acuity, as well as other factors such as contrast sensitivity and BAT to quantify the patient's improvement. This convention is satisfactory in most cases, however the subjective improvement may differ between patients with similar objective results. Although cataract surgery is relatively one of the safest and most effective procedures, surgeons still strive to find ways to achieve better results with shorter recovery times and less complications. To do this effectively, there must be a system to accurately determine the number of desirable outcomes, as well as adverse outcomes. Furthermore, it is essential to realize why these outcomes were either favorable or not. If we can determine which aspects of cataract surgery are most problematic and which are the most beneficial, then we can address these issues and implement alternative strategies to improve the results of surgery. For this to happen, we need not only accurate, but easy-to-use reporting systems that allow surgeons to see where they are having the most success and where they are making the most mistakes, as well as finding any sources of error in biometry and IOL calculation. The aim of this study is not only to report on the number of favorable and adverse outcomes and where problems may have arisen, but to also try and suggest a system that will facilitate the reporting systems at these clinics.
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